title: Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. A shortcoming of the laparoscopic approach in hematologic diseases.
abstract: BACKGROUND
  The ultimate goal of surgery for hematological disorders is the complete removal of both the spleen and accessory spleens in order to avoid recurrence of the disease. Whereas splenectomy by open surgery provides excellent results, the validity of laparoscopic splenectomy in this regard remains unknown.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the detection of accessory spleens during laparoscopic splenectomy for hematologic diseases.
  
  
  METHODS
  We therefore evaluated the pre-, intra-, and postoperative detection of accessory spleens in a consecutive series of 18 patients treated by elective laparoscopic splenectomy for hematological diseases by using computed tomography (CT) and denatured red blood cell scintigraphy (DRBCS).
  
  
  RESULTS
  Preoperative CT, DRBCS, and laparoscopic exploration detected 25%, 25%, and 75% of accessory spleens, respectively. At time of laparoscopy, 16 accessory spleens were detected in seven of the 18 patients (41%). In two patients (11%), laparoscopic exploration failed to detect accessory spleens, whereas preoperative CT (one case) and DRBCS (one case) did reveal them. Postoperatively, during a mean follow-up of 28 months (median, 24; range, 12-44 months), nine patients (50%) showed persistence of splenic tissue by DRBCS, and three of them had signs of disease recurrence.
  
  
  CONCLUSIONS
  This prospective clinical study suggests that elective laparoscopic surgery for hematological diseases does not allow complete detection of accessory spleens. Moreover, after such a laparoscopic approach, residual splenic tissue is detectable in half of the patients during the follow-up.
authors.affiliation: Department of Surgery, Saint-Luc University Hospital (Louvain Medical School), Brussels, Belgium.
authors.forename: J F
authors.initials: JF
authors.lastname: Gigot
authors.forename: F
authors.initials: F
authors.lastname: Jamar
authors.forename: A
authors.initials: A
authors.lastname: Ferrant
authors.forename: B E
authors.initials: BE
authors.lastname: van Beers
authors.forename: B
authors.initials: B
authors.lastname: Lengele
authors.forename: S
authors.initials: S
authors.lastname: Pauwels
authors.forename: J
authors.initials: J
authors.lastname: Pringot
authors.forename: P J
authors.initials: PJ
authors.lastname: Kestens
authors.forename: P
authors.initials: P
authors.lastname: Gianello
authors.forename: R
authors.initials: R
authors.lastname: Detry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery; D011877:Radionuclide Imaging; D012008:Recurrence; D013154:Spleen / Q000002:abnormalities* / Q000000981:diagnostic imaging; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000000981:diagnostic imaging; D017890:Splenosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed